脑电双频指数监测在肝功能不全患者手术麻醉中的应用

目的肝功能不全患者术中应用脑电双频指数（BIS）监测反馈调控麻醉药的靶控输注浓度，观察其对麻醉用药量和苏醒时闯的影响。方法肝功能不全患者40例，Child—Pugh分级A级，ASAⅡ或Ⅲ级，随机分为2组，每组20例。两组均静脉注射丙泊酚2mg／kg，咪达唑仑0．05mg／kg，雷米芬太尼3μg／kg进行麻醉诱导，并复合顺式阿曲库铵0．2mg／kg后行气管插管。靶控输注丙泊酚（初始血浆靶浓度0．7—1．8μg／L）、雷米芬太尼（初始效应室靶浓度2．5～3．5ng／L）以进行麻醉维持。对照组以常规监测指标调控靶控输注浓度；BIS组以BIS值（40～55）为指标反馈调控靶控输注浓度。术中监测血压（BP）、心电图（ECG）、脉搏氧饱和度（SpO2）以及BIS等指标，并记录麻醉维持阶段药物用量变化及麻醉苏醒时间，患者术中知晓情况。结果BIS组麻醉维持阶段丙泊酚用量显著低于对照组（4．9±0．2）mg／kg v．s．（6．7±0．4）mS／kg，P〈0．05]；BIS组麻醉苏醒时间显著短于对照组（7．0±1．5）min v．s．（11．0±1．4）min，P〈0．05]；两组均未发生术中知晓。结论BIS监测指导肝功能不全患者术中麻醉维持，可在保证适＂-3麻醉深度的情况下有效减少丙泊酚用量，缩短苏醒时间。

Application of bispectral index monitoring in hepatic insufficiency patients undergoing surgical procedures

Objective This prospective study was designed to evaluate the effect of bispectral index （BIS） monitoring on anesthetic use and recovery characteristics in hepatic insufficiency patients undergoing surgical procedures. Methods Forty consenting hepatic insufficiency patients （ Child - Pugh class A ; ASA II - III ） scheduled for Hassab or cholecystectomy procedures were divided into 2 groups randomly （ n = 20 for each）. Anesthesia was induced with propofol （2 mg/kg）, midazolam （0.05 mg/kg）, remifentanil （3 μg/kg）. Tracheal intubation was facilitated with atracurium （0.2 mg/kg） in all patients. Maintenance of anesthesia was induced with target - controlled infusion （TCI） of propofol （ initial target plasma concentration 0.7 - 1.8 μg/L ） and TCI of remifentanil （ target effect - site concentration 2.5 - 3.5 ng/L）. In BIS group, anesthetic delivery was adjusted in an effort to achieve a target BIS of 40 - 55 during maintenance. In control group, anesthetic was administered according to standard methods. BP, ECG, SpO2, BIS value, and so on, were recorded during anesthesia and operation. In addition, anesthetic consumption and recovery times were recorded. All patients were followed up on the 1 st and 7th days postoperatively to investigate the incidence of awareness during operation. Results The propofol consumption in the BIS group was lower significantly than that in control group （4.90 ± 0.2 mg/kg vs. 6.67 ± 0.4 mg/kg, P 〈 0.05 ）. Besides, compared with control group, BIS group had shorter time to awaken （7 ± 1.5 min v. s. 11 ± 1.4 min, P 〈 0.05 ）. Patients in both groups were extubated successfully and had no incidence of awareness during operation. Conclusion BIS monitoring the depth of anesthesia during surgical procedures in hepatic insufficiency patients can decrease the propofol consumption as well as shorten the recovery time while providing an adequate anaesthesia.